PMS, ABNORMAL PERIODS, AND INFERTILITYAN AMERICAN EPIDEMIC

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According to the January, 2011 issue of the Journal of Women's Health (Core Symptoms That Discriminate Premenstrual Syndrome), "More than 20% of menstruating women experience premenstrual syndrome (PMS) to a degree that warrants clinical treatment." The "core symptoms" that this study listed were, "anxiety/tension, mood swings, aches, appetite/food cravings, cramps, and decreased interest in activities." The American Psychological Association (Is PMDD Real?) took this a step further by talking about the up to, "9 percent of women who experience premenstrual changes so severe they can't keep up their daily routines". Beyond what were described above, the symptoms mentioned by the APA included DEPRESSION, FATIGUE, INSOMNIA, and food cravings that could probably be described as 'pathological' (more on this momentarily). But what about the number of women dealing with a "normal" amount of PMS?

Our government's National Women's Health Information Center (NWHIC) says that 3 out of 4 women deal with regular PMS, while between 1 in 3 and 40% suffer, "impairment of daily activity" due to their PMS. According to the same group, between 3-8% women have debilitating PMS symptoms. The Webiste "Florida Hospital" (the central website of the nearly 90 hospitals run by the Florida Seventh Day Adventists) says in the article,Statistics on Premenstrual Syndrome (PMS), that, "Almost 85% of American women experience premenstrual syndrome in the childbearing years, with about 5% of these women disabled by PMS due to the extremely severe symptoms. Symptoms can get worse as patients age and approach menopause." With approximately 160 million females living in the United States, and those between the ages of 11 and 48 having a monthly period, you should begin to get some kind of idea of how far-reaching this problem is.

Once we start looking at PCOS, things get even crazier. PCOS (Polycystic Ovarian Syndrome) is estimated to affect as many as 20 percent of menstruating American women. The December 2013 issue of the Journal of Clinical Epidemiology (Epidemiology, Diagnosis, and Management of Polycystic Ovary Syndrome) reveals that, "The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but is as high as 15%–20% when the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine criteria are used." PCOS is a deal-breaker for women who are wanting to get pregnant, as our own government (the NIH's Polycystic Ovary Syndrome (PCOS) Fact Sheet) reveals that, "PCOS is the most common cause of female infertility."

Because we can legitimately say that female-problems in American women could easily be called an "epidemic," it would behoove us to figure out what to do about them. The medical community is using the same methods they've used for decades ---- their usual repertoire of drugs (birth control pills, DIABETES DRUGS, ANTIDEPRESSANTS, SLEEPING PILLS, etc, etc, etc) to treat the symptoms of these problems. But is this the best or even most effective way to go about solving this all-too-common problem? Of course it's not. If you simply follow the links, you'll quickly notice that the side effects of these specific drugs are numerous, potentially severe, and DRAMATICALLY UNDER-REPORTED --- and are doing little besides masking symptoms. Today I want to show you what I believe has the best chance of helping you actually control your symptoms by addressing their root cause ---- a much better solution than 'pill popping'.

CONTROL YOUR BLOOD SUGAR: The truth is, I could start virtually every single post I write by making this same suggestion; CONTROL YOUR BLOOD SUGAR. This is because either directly or indirectly, BLOOD SUGAR is being linked to whatever ails you. The thing is, in PCOS it is the number one factor (see my earlier link on PCOS), and the reason that it is virtually always treated with the same drugs used to treat TYPE II DIABETICS. How do you control your blood sugar, and cut out reactive (INFLAMMATORY) foods such as GLUTEN? Simple --- you do a PALEO-LIKE DIET that is based on WHOLE FOOD NUTRITION (the same "Whole Food" principles hold true for any supplementation that you do, and there are some beneficial supplements out there for female problems). Because OBESITY (particularly BELLY FAT) is so heavily associated with PCOS, the right diet (Paleo) kills two birds with one stone by addressing this as well.

EXERCISE PROPERLY: One of the dirty little secrets of the fitness industry is that exercise does not promote WEIGHT LOSS nearly to the degree that diet does (HERE). What exercise helps with dramatically, however, is improving one's RESISTANCE TO INSULIN. The August 2010 issue of Human Reproduction Update (Exercise Therapy in Polycystic Ovary Syndrome: A Systematic Review) looked at a number of studies on this specific issue and concluded that, "The most consistent improvements were improved ovulation, reduced insulin resistance (9–30%) and weight loss (4.5–10%). Improvements were not dependent on the type of exercise, frequency or length of exercise sessions." The exercise protocols studied lasted 12 to 24 weeks. For the record, I am a fan of exercise programs that are heavy on resistance training, light on the cardio, and can be knocked out in 20 minutes or so (HERE).

GET RID OF TOXIC HORMONES IN YOUR SYSTEM:ESTROGEN DOMINANCE (whether caused by endogenous estrogen, exogenous estrogen, or both), along withMASSIVE CARBOHYDRATE CONSUMPTION / ADDICTION, are two of the hallmarks of the female problems we are discussing today. If you want to clear hormones and XENOHORMONES from your system (something you'll have to do to solve this problem), HERE is how to go about it (I explain Phase I, II, and III detoxification in this post). Don't forget that you'll need plenty of FIBER to bind the excess hormones and pass them out of your system with your waste (as a side note, fiber happens to be the very thing that feeds your good bacteria).

FIX YOUR GUT: Once you have dealt with excess estrogen, you'll have to deal with the HEALTH OF YOUR GUT. This is true not just because improper elimination causes resorption of toxins (HERE), but because it will help you in your two-pronged endeavor by both solving your LEAKY GUTand reversing your DYSBIOSIS. In light of this and the previous bullet point, try this one on for size. The April, 2012 issue of Gender Medicine (Do Fluctuations in Ovarian Hormones Affect Gastrointestinal Symptoms in Women With Irritable Bowel Syndrome?) reviewed 18 scientific studies on the relationship between Gut Health and female problems (the paper has nearly 100 studies in its bibliography), coming to an interesting conclusion concerning female problems and IBS. "An increase in gastrointestinal (GI) symptoms, including bowel discomfort, abdominal pain/discomfort, bloating, and alterations in bowel patterns, has been reported during premenses and menses menstrual cycle phases and the perimenopause period in women with and without irritable bowel syndrome (IBS). One study reported that visceral pain sensitivity was significantly higher during menses than at other menstrual cycle phases in women with IBS. Other menstrual cycle phase–linked symptoms, dysmenorrheal symptoms (cramping pain) in particular, were more intense in women with IBS."

FIX YOUR GUT (PART II): For those of you wondering how things like Dysbiosis or Leaky Gut Syndrome could potentially cause problems like PMS or PCOS, look no further. A study published in the July, 2012 issue of Medical Hypothesis (Dysbiosis of Gut Microbiota (DOGMA) – A Novel Theory for the Development of Polycystic Ovarian Syndrome) spills the beans via its title. We have known for quite some time that PCOS is intimately linked to Obesity, and that Obesity is intimately linked to one's MICROBIOME (HERE, HERE, HEREand HERE are a few examples). This study confirms the link between the Microbiome and PCOS by saying in its abstract that, "Polycystic Ovarian Syndrome (PCOS) is the most common cause for menstrual disturbance and impaired ovulation... As the majority of women with PCOS are either overweight or obese, a dietary or adipose tissue related trigger for the development of the syndrome is quite possible. This novel paradigm in PCOS aetiology suggests that disturbances in bowel bacterial flora ("Dysbiosis of Gut Microbiota") brought about by a poor diet creates an increase in gut mucosal permeability [Leaky Gut], with a resultant increase in the passage of lipopolysaccaride (LPS) from colonic bacteria into the systemic circulation. The resultant activation of the immune system interferes with insulin receptor function, driving up serum insulin levels, which in turn increases the ovaries production of androgens [TESTOSTERONE--- the reason that women with PCOS are usually hairy] and interferes with normal follicle [egg] development. Thus, the Dysbiosis of Gut Microbiota (DOGMA) theory of PCOS can account for all three components of the syndrome-anovulation/menstrual irregularity, hyper-androgenism (acne, hirsutism) and the development of multiple small ovarian cysts."

GET PROPER SLEEP: While this would be a generic suggestion for any chronic health issue, it is particularly important for dealing with female issues such as PMS and PCOS. Just a few short months ago, the journal Sleep Medicine Reviews published a study calledSleep, Sleep Disturbance, and Fertility in Women. The authors state that, "Sleep and sleep disturbances are increasingly recognized as determinants of women's health and well-being, particularly in the context of the menstrual cycle, pregnancy, and menopause." In similar fashion to the previous bullet point, they go on to present, "A model whereby stress, sleep dysregulation, and circadian misalignment are delineated for their potential relevance to infertility." The August 2009 issue of the Journal of Psychosomatic Research (Morningness / Eveningness and Menstrual Symptoms in Adolescent Females) takes this concept a bit further by saying, "Two types of sleep preference have been supported in the literature. Morning types awaken early and are refreshed upon waking, whereas Evening types rise later and have more erratic sleep schedules. Sleep affects menstrual functioning in adult women. Adolescent girls with Evening preference experience more menstrual symptoms than those with Morning preference." This all has to do with 'Circadian Rhythms,' which brings us to a couple more studies on the topic.

GET PROPER SLEEP (PART II): The September 2007 issue of Sleep Medicine (Circadian Rhythms, Sleep, and the Menstrual Cycle) reveals that, "Disruption of circadian rhythms is associated with disturbances in menstrual function. Female shiftworkers compared to non-shiftworkers are more likely to report menstrual irregularity and longer menstrual cycles. There also is accumulating evidence that circadian disruption increases the risk of breast cancer in women." Furthermore, a study published two months previous to that in the Biological Research for Nursing (Light Exposure, Melatonin Secretion, and Menstrual Cycle Parameters: An Integrative Review) concluded that, "Dysfunction in menstrual physiology has pronounced effects on quality of life, involving mood changes, body image, infertility, and pregnancy complications. Light exposure may affect menstrual cycles and symptoms through the influence of melatonin secretion. There is evidence of a relationship between light exposure and melatonin secretion and irregular menstrual cycles, menstrual cycle symptoms, and disordered ovarian function. In women with a psychopathology such as bipolar disorder or an endocrinopathy such as polycystic ovary syndrome, there seems to be greater vulnerability to the influence of light-dark exposure."

DEAL WITH STRESS:The truth is that this is often easier said that done. However, it is critical because when you foul up the HPA (HYPOTHALAMUS / PITUITARY / ADRENAL) Axis, your chances of developing not only female issues, but FIBROMYALGIA (itself heavily associated with female problems) skyrocket. Almost a decade ago, an issue of Current Opinions in Obstetrics & Gynecology revealed that, "Increasingly, gynecologists are becoming aware of the impact of psycho-social factors on women's health generally, and on the menstrual cycle in particular. Stress impairs the ovarian cycle through activation of the hypothalamus pituitary adrenal axis. The effect of psychological stress on the menstrual cycle is mediated by metabolic factors. Stress-induced impairment of ovarian function may not necessarily manifest as menstrual irregularity, and the effects of stress may persist beyond the cycle in which the stress episode occurred. Interventions to address underlying stress should be part of the management regime for women with menstrual cycle abnormalities." Here are some other studies on this topic.

- The June, 2014 issue of the Journal of Psychosomatic Obstetrics & Gynecology (Dispositional Resilience as a Moderator of the Relationship Between Chronic Stress and Irregular Menstrual Cycle) said that, "Menstrual-cycle irregularity may have an important influence on the subsequent development of chronic diseases. Several risk factors for irregular menstrual cycles have been detected, including stress."

- A 2009 edition of the Journal of Physiological Anthropology (The Relationship Between Premenstrual Symptoms, Menstrual Pain, Irregular Menstrual Cycles, and Psychosocial Stress Among Japanese College Students) concluded, "Both stress score and body mass index were found to be significant predictors for having experienced irregular menstrual cycles. The results suggest that psychosocial stress is independently associated with premenstrual symptoms and the experience of irregular menstrual cycles....."﻿- Similarly, the July, 2013 issue of the Journal of Obstetrics and Gynecology (Does Psychosocial Stress Influence Menstrual Abnormalities in Medical Students?) revealed that, "students who reported premenstrual symptoms, irregular cycles and dysmenorrhoea severe enough to take medication had significantly higher mean Perceived Stress Scale scores. High stress was significantly associated with occurrence of premenstrual symptoms and dysmenorrhoea severe enough to take medication."

- The March, 2008 issue of Harefuah (a journal published by the Israeli Medical Association) concluded in a study called Stress and Distress in Infertility Among Women that, "In the industrialized world, approximately 12% of couples suffer from infertility. Studies have accumulated information regarding the contribution of psychological factors to infertility in women. Among the identified risk factors are depression, anxiety and stress-dependent changes like altered heart rate and increased blood cortisol levels. From the studies presented in this review it can be hypothesized that stress can induce altered cortisol-excretion patterns along the menstrual cycle, which ultimately affect the hormonal profile in critical stages of the fertilization process."

SUMMARY: In all honesty, today's post is not so different from any number of posts I have done in the past that involve solutions for Chronic Inflammatory Degenerative Diseases, Autoimmunity (HEREand HEREare lists) and even many cases of CHRONIC PAIN. I am not trying to be mean or pessimistic, but you will not find your own personal EXIT STRATEGY with a protocol whose foundation is based on the drugs that your doctors continue to load you up on. To begin to solve almost any health problem, I would suggest you START HERE. Sure, there are some of you who are going to need to go beyond this and get some specific metabolic or FUNCTIONAL NEUROLOGICAL testing done. But any changes needed will be minor if you are already on board and working your program.

Hi Doctor Schierling. Both my girlfriend, who is an accomplished yoga teacher and also works with restorative yoga, and myself have been following you for a couple of years now. We have both benefitted from going paleo/lo carb. One thing has struck us both and that is a certain bodytype among mainly women with hypermobility: they are often overweight or even obese. Do you know of any connection between a hi carb diet throughout childhood possibly effecting the quality and strength of connective tissue? That in some way muscle skeletal system goes haywire at an early stage of development, maybe even in the womb? We would be grateful for any comments. If anybody knows we thought you would. Thanks for a great and insightful site.

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Dr. Russ

11/25/2015 02:08:13 am

Hello Robin,

I recognize you from comments on Facebook. BTW, thanks for the kudos. The truth is, as I research, I am finding a connection between almost every imaginable health issue and a high glycemic diet. However, I have not noticed this specific problem. Might be interested in a guest post from the two of you concerning the benefits you've seen with going Paleo. Have a great Thanksgiving (although for some reason I was thinking you live outside the US).

Sincerely,
Russ S

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Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).